scholarly journals Patient-reported adverse drug-related events from emergency department discharge prescriptions

CJEM ◽  
2010 ◽  
Vol 12 (04) ◽  
pp. 331-338 ◽  
Author(s):  
Corinne M. Hohl ◽  
Riyad B. Abu-Laban ◽  
Peter J. Zed ◽  
Jeffrey R. Brubacher ◽  
Gina Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Time Frame ◽  
Tertiary Care Centre ◽  
Crude Odds Ratio ◽  
Patient Reported ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Emergency Department Discharge ◽  
Research Assistants

ABSTRACTObjective:The tolerability of drugs prescribed on emergency department (ED) discharge is unknown. Our objectives were to quantify and describe adverse drug-related events (ADREs) as reported by patients triaged as Canadian Emergency Department Triage and Acuity Scale scores 3, 4 or 5, discharged from the ED with prescriptions.Methods:This prospective observational study was a planned substudy of a larger study on adherence to discharge prescriptions. This study was conducted in a tertiary care centre with an annual ED census of 69 000 visits. The primary outcome was the frequency of ADREs reported during a structured telephone questionnaire 2 weeks after ED discharge. An ADRE was deemed to have occurred if the patient reported a symptom consistent with a known ADRE that began and resolved within a plausible time frame after starting and stopping the drug, and if no alternative diagnosis was probable.Results:Research assistants contacted 258/301 (85.7%) patients discharged from the ED with a prescription. An ADRE was reported by 54/258 patients (20.9%, 95% confidence interval [CI] 16.4%–26.3%). The most commonly reported ADREs were nausea, constipation and drowsiness. None required hospital admission or caused death. Participants reporting ADREs were not more likely to make an unplanned ED or clinic revisit (crude odds ratio [OR] 1.1, 95% CI 0.6–2.2; adjusted OR 1.2, 95% CI 0.6–2.4).Conclusion:Approximately one-fifth of low-acuity patients prescribed medication on discharge from the ED report ADREs, but most of these are neither severe nor associated with an increase in use of health services. Attention to common preventable ADREs, such as opioid-associated constipation, could reduce the rate of ADREs in this population.

scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

scholarly journals P060: Cannabinoid hyperemesis syndrome presentation to the emergency department: a two-year multi-centre retrospective study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S98-S99 ◽  
Author(s):  
J.M. Hernandez ◽  
J. Paty ◽  
I. Price
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Case Series ◽  
Kappa Statistic ◽  
Cannabis Use ◽  
Data Abstraction ◽  
Tertiary Care Centre ◽  
Associated Symptoms ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Ed Visits

Introduction: Cannabinoid hyperemesis syndrome (CHS) is a paradoxical side effect of cannabis use. Patients with CHS often present multiple times to the Emergency Department (ED) with cyclical nausea, vomiting and abdominal pain, and are discharged with various misdiagnoses. CHS studies to date are limited to case series. We examined the epidemiology of CHS cases presenting to two major urban Tertiary Care Centre EDs. Methods: Using explicit variables, trained abstractors, and standardized abstraction forms, we abstracted data for all adults (18-55 years) with a presenting complaint of vomiting, and/or a discharge diagnosis of vomiting and/or cyclical vomiting, during a 2-year period. Inter-rater agreement was measured using a kappa statistic. Results: We identified 494 cases: mean age 31 years; 36% male; only 19.4% of charts specifically reported cannabis use. Among the regular cannabis users (>3 times per week), 43% had repeat ED visits for similar complaints. Interestingly, of these patients, 92% had bloodwork done in the ED, 92% received IV fluids, 89% received anti-emetics, 27% received opiates, 19% underwent imaging, 8% were admitted to hospital, and 8% were referred to the Gastroentorology service. Inter-rater reliability for data abstraction was kappa = 1. Conclusion: This study suggests CHS may be an overlooked diagnosis for nausea and vomiting, a factor which can possibly contribute to unnecessary investigations and treatment in the ED. Additionally, this indicates a lack of screening for CHS on ED history, especially in quantifying cannabis use and eliciting associated symptoms of CHS.

scholarly journals A cross-sectional study of sexual function and fertility status in adults with congenital genitourinary abnormalities in a U.S. tertiary care centre

2018 ◽  
Vol 13 (3) ◽  
Author(s):  
Hannah McCloskey ◽  
Aaron Kaviani ◽  
Rashmi Pande ◽  
Timothy Boone ◽  
Rose Khavari
Keyword(s):  
Sexual Function ◽  
Assisted Reproductive Technologies ◽  
Tertiary Care ◽  
Reproductive Technologies ◽  
Time Frame ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Fertility Status

Introduction: We aimed to evaluate sexual function, sexual knowledge, and fertility status in adult patients with congenital genitourinary abnormalities (CGUA). Methods: Adult patients with CGUA who were referred to a single transitional urology clinic between 2014 and 2017 were prospectively recruited to participate in the study. Questionnaires about general demographics, bowel and bladder continence, fertility, and sexuality were gathered. Validated questionnaires, including the Sexual Health Inventory for Men (SHIM) and Brief Index of Sexual Functioning for Women (BISF-W), were also collected. Results: A total of 167 adults with CGUA were referred to our clinic within the defined time frame. Sixty patients (25 males, 35 females) with a mean age of 25.4 years (range 18–75) met inclusion criteria and responded to questionnaires pertaining to sexuality and fertility. Forty-five (75%) responded to the fertility questionnaire; 26 (58%) had never heard of assisted reproductive technologies, and only one had received prior fertility counselling. Fifty-eight participants (97%) responded to the sexuality questionnaire; 21 (36%) reported a history of sexual activity, with 12 (21%) being currently sexually active. Twenty (34%) wanted to learn more about sexuality and/or fertility. The SHIM response rate was 44%, and only three females (9%) completed the BISF-W in its entirety. Conclusions: Adults with CGUA desire more sexuality and fertility education, yet they are uncomfortable completing current questionnaires. Our sexuality and fertility questionnaires are too challenging for this patient population to complete despite assistance. Thus, modifications are urgently needed. Additionally, medical providers should discuss sexual and reproductive health with these patients earlier and in more detail.

Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 45-49 ◽  
Author(s):  
Clémence Dallaire ◽  
Julien Poitras ◽  
Karine Aubin ◽  
André Lavoie ◽  
Lynne Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Communication ◽  
Vital Signs ◽  
Prehospital Setting ◽  
Interrater Agreement ◽  
Base Hospital ◽  
Emergency Department Nurses ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Κ Statistic

ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.

Patient-Reported Adverse Drug Related Events from Emergency Department Discharge Prescriptions

2007 ◽  
Vol 14 (5 Supplement 1) ◽  
pp. S194-S194
Author(s):  
C. Hohl ◽  
A.-R. Laban ◽  
P. Zed ◽  
J. Brubacher ◽  
G. Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Reported ◽  
Emergency Department Discharge

scholarly journals A prospective evaluation of the availability and utility of the Ambulance Call Record in the emergency department

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Natalie Cram ◽  
Shelley McLeod ◽  
Michael Lewell ◽  
Matthew Davis
Keyword(s):  
Emergency Department ◽  
Patient Management ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Relevant Information ◽  
Care Centre ◽  
Prospective Evaluation ◽  
Tertiary Care Centre ◽  
Handover Process ◽  
Collection Form

AbstractObjectiveTo determine how often the Ambulance Call Record (ACR) was available to emergency department (ED) physicians and whether it contained information that changed the ED management of patients.MethodsThis was a prospective cohort study of adult patients transported to one of two tertiary care centre EDs. Physicians completed a data collection form for each patient regarding ACR availability and the perceived value of the ACR. This study began shortly after the implementation of a new electronic ACR (eACR) handover process (Round 1). To control for any confounding factors related to this new eACR handover process, the study was repeated 6 months after its implementation (Round 2).ResultsTotal of 869 forms were collected: 545 in Round 1, and 324 in Round 2. The ACR was available at first physician assessment for 82 (15.7%) patients in Round 1, and 76 (24.4%) patients in Round 2 (Δ8.7%, 95% CI: 3.1%, 14.5%). The ACR was available at some point during patients’ ED stay for 154 (28.9%) patients in Round 1, compared to 111 (34.5%) patients in Round 2 (Δ5.6%, 95% CI: 0.0%, 12.1%). When the ACR was available for a patient (n=265), physicians believed that information in the ACR changed their treatment plan in 76 (28.8%) cases.ConclusionPhysicians who review the ACR believe that the ACR contains relevant information that may influence patient management; however, physicians commonly manage patients without reviewing the ACR.

scholarly journals Emergency department use by CTAS Levels IV and V patients

CJEM ◽  
2006 ◽  
Vol 8 (05) ◽  
pp. 317-322 ◽  
Author(s):  
Simon Field ◽  
Andrea Lantz
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Tertiary Care ◽  
Patient Survey ◽  
Medical Problem ◽  
Primary Objective ◽  
Specific Service ◽  
Timely Access ◽  
Emergency Department Triage ◽  
Ed Visits

ABSTRACT Introduction: Many emergency department (ED) visits are non-urgent. Postulated reasons for these visits include lack of access to family physicians, convenience and 24/7 access, perceived need for investigations or treatment not available elsewhere, and as a mechanism for expedited referral to other specialists. We conducted a patient survey to determine why non-urgent patients use our tertiary care ED. Our primary objective was to determine how often the lack of a family physician was associated with non-urgent ED use. Methods: The survey was administered to Canadian Emergency Department Triage and Acuity Scale (CTAS) Level IV and V patients who attended the ED of the Queen Elizabeth II Health Sciences Centre in Halifax, NS, from March 7 to March 13, 2005. Results: Of the 352 eligible patients, 235 completed the survey (response rate, 67%). Fifty-six percent (132/235) had an acute medical problem of less than 48 hours, including 48% (114/235) with a recent injury. Thirty-four percent (82/235) had been referred to the ED, 49% (114/235) believed they required a specific service that was unavailable elsewhere (e.g., radiology, suturing, casting) and 43% (100/235) presented because of self-perceived urgency of their condition. Eighty-four percent (198/235) had a family physician; 23% (55/235) used the ED because of limited access to theirfamily physician and 3% (6/235) used the ED because they did not have a family physician. Conclusions: In this setting, most non-urgent ED visits involved patients who required a specific service offered by the ED, patients who believed their condition was urgent, or patients who were referred from the community to the ED. From a patient perspective, relatively few visits would be considered inappropriate. Lack of a family physician was not associated with non-urgent ED use; however, inability to obtain timely access to the FP was a factor in one-quarter of cases.

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

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